Ann Generlich outlines the relationship between oral malodour, dental plaque biofilms, caries, gingivitis and periodontitis.
Whilst both periodontal disease and tooth decay are associated with bacterial plaque, international researchers have known for some years that volatile sulphur compounds (VSC) are linked to cause periodontal disease. The two main sources of VSC have been identified as the tongue and the gingival tissues. VSC such as hydrogen sulphide, methyl mercaptan and dimethyl sulphide break down the resistant barrier of the periodontium. As the severity of the periodontal breakdown increases so too does the presence of VSC. Oral malodour is often considered to be a cosmetic problem, but there is increasing scientific evidence to show that its causes are linked to the development of periodontitis.
The late eminent US periodontist, Prof Ratcliff maintained that the causes of periodontal disease are a combination of many processes, including activation of the immune system, alterations in connective gingival tissue metabolism, production of proteinases and cytokines and the destruction of host tissue by bacterial enzymes along with a multitude of other factors.
'The disease process is therefore not necessarily a sequential series of events, but rather a consequence of concurrent processes, which work together to destroy tissues.' He claimed that extremely low concentrations of VSC, the family of gases which are primarily responsible for oral malodour, are also highly toxic to the tissues in the mouth. When VSC are absent, the toxins from bacteria do not cross the epithelial barrier. When the VSC are present, they alter the epithelial barrier, allowing the bacterial toxins to penetrate through the epithelium into the deeper tissues. These act as antigens to start the immune response, which starts the inflammatory reaction that causes tissue destruction to form periodontal pockets.
The oxygen generated by stabilised chlorine dioxide restores the oxygen in saliva and plaque. If oxygen is present, the anaerobic bacteria cannot survive. Since the anaerobic bacteria are associated with periodontitis, reducing their growth potentially helps prevent the formation of periodontal pockets and bone loss. Research has shown, and experts agree, that there is an association between periodontal diseases and other chronic⇐ ⇔inflammatory conditions, such as diabetes, cardiovascular disease and Alzheimer's disease. Therefore, treating inflammation may help manage periodontal diseases and also help with the management of other chronic inflammatory conditions.
Reducing bacteria decreases the amount of hydrogen sulphide and methyl mercaptan (and this then reduces the amount of free cysteine and methionine). All these compounds play a particular role in the causes of periodontitis and gingivitis.
Prof Ratcliff developed a chlorine dioxide based oral care range which actively treats oral malodour and controls periodontal disease. Chlorine dioxide breaks the molecular structure of the sulphur bonds through a process of oxidation rendering them odourless.
He explained: 'Traditional procedures of scaling, root planing and the practice of oral hygiene, combined with tongue scraping are effective at reducing levels of VSC in mouth air and are a satisfactory cosmetic treatment. However oral care products which can demonstrate efficacy at lowering concentrations of VSC in periodontal pockets may also be significant adjuncts to periodontal therapy as they help to prevent gingival disease.' Prof Ratcliff said the link between oral malodour and periodontitis has implications for treatment.
Other precursors to gingivitis are undisturbed dental plaque biofilms. Treatment of both gingivitis and chronic periodontitis is designed to facilitate the frequent removal and disruption of plaque biofilms. Periodontal diseases, gingivitis, and periodontitis are associated with bacterial plaque. Studies have shown that gingivitis will develop within 10-21 days if all oral hygiene practices are stopped and plaque is allowed to build up undisturbed. Gingivitis is preventable by routine oral care, but if untreated may lead to periodontitis.
Products containing activated stabilised chlorine dioxide, an oxidising agent and a compound with antimicrobial/anti-bacterial properties against oral bacteria, are effective treatments for gingivitis and oral malodour. Its unique oxidation process results in several beneficial actions such as destroying micro-organisms and eliminating odours. It has been shown by independent research laboratories and universities to be extremely effective against a broad spectrum of bacteria, fungi, viruses and other microbial agents. Both gram positive and gram negative organisms display susceptibility to the oxidising power of chlorine dioxide.
A stabilised chlorine dioxide oral rinse (like RetarDEX) reduces bacterial counts of a range of bacteria.
When dental care professionals are considering recommending oral healthcare products it would be advisable to no longer separate oral health from overall health.